BlueCard® OverviewAs a participating provider with BlueShield of Northeastern New York, you may see members of other BlueCross and/or BlueShield plans who travel or live in our service area.

The BlueCard® program links you with these members’ local BlueCross and/or BlueShield plans through a single electronic network for claims processing and reimbursement. You conveniently submit claims for out-of-area patients to us. We’re your point of contact for claims payment, problem resolution, and adjustments.

Visit bsneny.com/provider and click the BlueCard tab for more information.

If you have any questions about the BlueCard program, please call us at 1-800-444-2012. We’d be happy to assist you.

BlueShield of Northeastern New York is a division of HealthNow New York Inc., an independent licensee of the Blue Cross and Blue Shield Association.12251_NENY_10_17

(over)

Appeals

• Claims that have been denied for the following reasons may be appealed:o Experimental/investigationalo Cosmetico Medical necessity

• The Post Service Appeal Form can be found at bsneny.com/provider > Tools & Resources > Forms

Corrected claims

• Corrected claims must contain all lines being billed, not just changes being made.• Electronic adjustments have a note field where you can indicate any changes being made.

Medicare crossovers

• When you receive remittance advice from a Medicare intermediary, verify that the claim has beenautomatically forwarded (crossed over) to the Blue plan. If the remittance indicates that the claimwas crossed over, Medicare has forwarded the claim on your behalf to the appropriate Blue plan andit is being processed. You don’t need to resubmit the claim to us.

• For claims processing and payment information, please contact the Home plan directly if Medicarehas crossed over.

Utilization management (UM) review

• A letter of explanation from a doctor and an operative/procedure report is required:o When you disagree with our bundling edits

Provider inquiries

• Please remember to:o Include member ID and claim numbers on all correspondenceo Make sure your questions are clear and conciseo Fill out all forms fully and legibly

Billing requirements for ancillary claim services

• File the claim with the plan located in the service area:o Durable medical equipment (DME) — where the equipment was shipped or purchased fromo Independent clinical labs — where the ordering/referring doctor is locatedo Specialty pharmacy — where the ordering/referring doctor is located

The referring doctor’s name and National Provider Identifier (NPI) are required on all claims.

• If you know that your patient will be leaving the area (i.e., Florida for the winter), have lab and/orspecialty pharmacy services rendered before he or she leaves.

Electronic provider access (EPA)

The EPA tool allows you to conduct pre-service reviews online, such as precertifications or preauthorizations.

Access is simple:• Visit bsneny.com/provider• Click BlueCard, then Out-of-Area Policy Search• Choose the type of information you’re requesting, enter the patient’s three-letter prefix, and click Go.

This will take you to the home plan’s landing page or a vendor website. If the plan does not have this electronic capability, a number will be provided that you can call to conduct the review.

BlueCard®

Tips